If and when negotiations for a new contract begin, many hope they will herald the start of a very different role and funding structure for community pharmacies.
The Pharmaceutical Services Negotiating Committee (PSNC) will be pressing for the inclusion of a broad ‘care plan service’, with pharmacists supporting patients with long-term conditions, as a key plank of any new contract.
Locally commissioned versions of these services already exist around the country, with pharmacists managing asthma, encouraging self-care in young people with diabetes, and screening for coeliac disease or chlamydia.
But most of these are pilot schemes, many now finished, and all of them occur only sporadically around the country where enthusiastic pharmacists and/or forward-thinking commissioners decide there is an opportunity for innovative practice.
The six advanced services included as part of the current community pharmacy framework, such as medicines use reviews and the new medicine service, were an important step forward in the role of community pharmacy. They also provide good foundations for a nationally negotiated deal.
Speaking to pharmacists around the country, The Pharmaceutical Journal has found considerable agreement about the direction of change, but differences in opinion over how change should be implemented. For instance, should this new care management role sit on top of the existing contract? How would outcomes be recorded and remuneration be determined? What are the specific conditions that should be included?
There is also broad support from others in primary care. The PSNC has the backing of the British Medical Association, the Royal College of GPs and the Dispensing Doctors’ Association for its model of community pharmacy, although there remains a suspicion that GPs are onside mainly because they will take anything that helps relieve their workload.
And there are still a number of sticking points to the provision of a radically new community pharmacy contract, not least funding — the NHS is not brimming with cash — and there will also be cultural barriers to overcome, with many patients still regarding community pharmacy as semi-detached from the NHS.
The difference now is that the government is also falling into line. Pharmacy minister Steve Brine has agreed to talks with the PSNC, specifically saying he wants to move from a contract that rewards the dispensing of higher volumes of medicines to one that rewards care for patients.
But if community pharmacists are to extend their clinical reach, what will happen to their bread and butter of dispensing medicines? It is not necessarily the case that everyone in community pharmacy backs the creation of what have been called ‘mini-doctors’. Some, such as the Pharmacists Defence Association, believe the future for community pharmacy should be a much sharper focus on pharmacists’ real area of expertise: medicines and medicines supply.
And this fits nicely with the current policy trajectory from the Department of Health and Social Care. Patient safety, including the role of drug errors, has become something of a crusade for health and social care secretary, Jeremy Hunt.
The recent publication of figures highlighting the number of patients prescribed non-steroidal anti-inflammatory drugs without gastroprotection show a real need for the unique expertise pharmacists have; spotting this kind of risky prescribing is precisely the kind of area where pharmacists can show their worth, making a real difference to the care that patients in the NHS receive.
Negotiators must not forget pharmacy’s roots as they work to reform the community pharmacy contract.